Clinical Orthopaedics and Related Research®

, Volume 470, Issue 8, pp 2154–2160

Is Fixation Failure After Plate Fixation of the Symphysis Pubis Clinically Important?

  • Stephen A. C. Morris
  • Jeremy Loveridge
  • David K. A. Smart
  • Anthony J. Ward
  • Tim J. S. Chesser
Symposium: Disruptions of the Pelvic Ring: An Update

DOI: 10.1007/s11999-012-2427-z

Cite this article as:
Morris, S.A.C., Loveridge, J., Smart, D.K.A. et al. Clin Orthop Relat Res (2012) 470: 2154. doi:10.1007/s11999-012-2427-z

Abstract

Background

Plate fixation is a recognized treatment for pelvic ring injuries involving disruption of the pubic symphysis. Although fixation failure is well known, it is unclear whether early or late fixation failure is clinically important.

Questions/purposes

We therefore determined (1) the incidence and mode of failure of anterior plate fixation for traumatic pubic symphysis disruption; (2) whether failure of fixation was associated with the types of pelvic ring injury or pelvic fixation used; (3) the complications, including the requirement for reoperation or hardware removal; and (4) whether radiographic followup of greater than 1 year alters subsequent management.

Methods

We retrospectively reviewed 148 of 178 (83%) patients with traumatic symphysis pubis diastasis treated by plate fixation between 1994 and 2008. Routine radiographic review, pelvic fracture classification, method of fixation, incidence of fixation failure, timing and mode of failure, and the complications were recorded after a minimum followup of 12 months (mean, 45 months; range, 1–14 years).

Results

Hardware breakage occurred in 63 patients (43%), of which 61 were asymptomatic. Breakage was not related to type of plate, fracture classification, or posterior pelvic fixation. Five patients (3%) required revision surgery for failure of fixation or symptomatic instability of the symphysis pubis, and seven patients (5%) had removal of hardware for other reasons, including late deep infection in three (2%). Routine radiographic screening as part of annual followup after 1 year did not alter management.

Conclusions

Our observations suggest the high rate of late fixation failure after plate fixation of the symphysis pubis is not clinically important.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Stephen A. C. Morris
    • 1
  • Jeremy Loveridge
    • 1
  • David K. A. Smart
    • 2
  • Anthony J. Ward
    • 1
  • Tim J. S. Chesser
    • 1
  1. 1.Department of Trauma and Orthopaedics, Frenchay HospitalNorth Bristol NHS TrustBristolUK
  2. 2.Department of Trauma and OrthopaedicsHull and East Yorkshire Hospitals NHS TrustYorkshireUK